Provider Demographics
NPI:1558353177
Name:SPARKS, JOHN C JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:SPARKS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1020 RIVERWOOD CT.
Mailing Address - Street 2:#340
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304
Mailing Address - Country:US
Mailing Address - Phone:936-539-2663
Mailing Address - Fax:936-539-2664
Practice Address - Street 1:1020 RIVERWOOD CT.
Practice Address - Street 2:#340
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304
Practice Address - Country:US
Practice Address - Phone:936-539-2663
Practice Address - Fax:936-539-2664
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7351207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096941201Medicaid
E89815Medicare UPIN
TX096941201Medicaid